Comparative Analysis of 20‐Minute Neighbourhood Policies and Practices in Melbourne and Scotland

Twenty‐minute neighbourhoods highlight the importance of well‐connected and mixed‐used neighbourhoods and communities with proximate access to employment, essential services, public transport, and open spaces. Shorter distances together with re‐prioritised public spaces encourage more active transport choices, resulting in public health benefits and reduced environmental pollution. Higher liveability brought about by mixed‐use developments enables people to have equitable access to local facilities, amenities, and employment opportunities, promoting vibrancy, social cohesion, and intergenerational connections. The attributes of 20‐minute neighbourhoods also combine to create places, that are acknowledged as friendly for all ages, address changing needs across the life course, and provide better support for the ageing population. Furthermore, there are indications that 20‐minute neighbourhoods may be more resilient against many of the negative impacts of stringent public health protocols such as those implemented in periods of lockdown during the Covid‐19 pandemic. In this article, we evaluate and compare planning policies and practices aimed at establishing 20‐minute neighbourhoods in Melbourne (Australia) and Scotland (the UK). Using case studies, we discuss similarities and differences involved in using place‐based approaches of 20‐minute neighbourhoods to address 21st‐century challenges in key areas of health and wellbeing, equity, environmental sustainability, and community resilience. © 2022 by the author(s);licensee Cogitatio (Lisbon, Portugal).

Transcutaneous electrical nerve stimulation for at-home treatment of nocturnal enuresis in children: Determining optimal pad placement

Introduction: Nocturnal enuresis (NE) is a common problem encountered in children that can be recalcitrant to currently available treatment options. Neuromodulation techniques are used to treat various urologic disorders but can be limited by convenience and compliance. Transcutaneous electrical nerve stimulation (TENS) is a neuromodulator that can be used at home to treat various conditions. The aim of this study was to determine if TENS can be offered as an effective at-home option that shows durability for NE in children, and to determine which pad placement is the most efficacious. Materials & Methods: A randomized clinical trial including 90 patients aged 5-18 years presenting with monosymptomatic NE was performed. After one month of behavioral therapy, they were treated with TENS therapy after randomization to three groups based on pad placement: suprapubic (SP), parasacral (PS), and ankle/posterior tibial (PT). TENS therapy was performed nightly for one month. Voiding diaries recording the number of wet nights, wet scale severity score (0-3), TENS compliance, quality of life (QOL) questionnaires, and any adverse reactions were collected monthly at baseline, during TENS therapy, and after TENS for durability assessment, and statistically analyzed after study completion. Results: No patient was cured of NE, and our study failed to show a statistical difference between the study arms in enuresis frequency during TENS. The only statistically significant improvement was QOL during TENS therapy (2.95 improvement for the PT group versus 1.2 and 1.5 regression for SP and PS groups, respectively, p=0.003). PT TENS therapy also showed improvements for enuresis frequency with 2.7 less episodes/month (versus 4.1 and 8.2 more episodes/month in the SP and PS groups, respectively, p=0.06) and the severity of wetness each night with a 0.17 improvement (versus 0.06 and 0.13 regression in the SP and PS groups, respectively, p=0.06) after TENS therapy was completed, however these did not meet statistical significance. Patients were compliant with using TENS therapy (90% or more in all groups) and there were no adverse events. Discussion: This study found that patients who used the PT pad placement for TENS showed significant improvements in QOL during therapy, however we were unable to show a significant difference in enuresis frequency during TENS between groups. The major limitation of our study was the high number of patients lost to follow-up during the COVID-19 pandemic. Conclusion: TENS therapy when combined with behavioral techniques can be an easy and safe tool that can be used at home to help treat NE, however, further studies are needed to optimize this type of therapy to show a clinically significant benefit.

Emergency remote instruction in 2020: Differential impacts on science, technology, engineering, and mathematics students' confidence and belonging, by gender, race/ethnicity, and socioeconomic status

The COVID-19 pandemic forced higher education into emergency remote instruction in 2020. Impacts of this modality shift on undergraduates of different identities are important to document, for both current students who need support now and future students who may face other crises. A large survey in the United States asked students in science, technology, engineering, and mathematics (STEM) to report the impact of emergency remote instruction on their confidence to succeed and sense of belonging in STEM. Using those data, we find that the impact varies by gender, race/ethnicity, and socioeconomic status (SES). For instance, 63.3% of lower SES women identifying as underrepresented racial/ethnic minorities (URM) reported a decrease in their confidence to succeed, compared to 38.9% of non-URM, higher SES men who reported a decrease. On the other hand, 35.3% of URM, lower SES men reported that emergency remote instruction increased their sense of belonging, compared to 15.9% of non-URM, higher SES women. The large percentage reporting increased belonging was unexpected and adds to calls for more research into the experiences of URM men. Our results suggest researchers, instructors, and administrators working to mitigate shocks to higher education must consider multiple identities and take an intersectional view, because impacts of these crises are not neutral with respect to gender, race/ethnicity, and SES.

Incidence and significance of vitamin d deficiency at inflammatory bowel disease inception in the covid era

Background: Vitamin D, a key regulator of immune response, is known to be lower in Inflammatory Bowel Disease (IBD) patients than the general population. Disparity in the incidence of deficiency between ethnic groups has previously been demonstrated. We measured vitamin D in a unique multi-ethnic inception cohort to correlate this with traditional IBD scores and patient reported outcome measures including the 'IBD Disk'. Methods: Data regarding demographics, ethnicity, faecal calprotectin (FCAL) and baseline blood results including Vitamin D was collected prospectively from January-October 2021, from adults presenting with suspected IBD. Montreal classification, Harvey-Bradshaw Index or Partial Mayo score, endoscopic disease severity indices and IBD Disk score were documented in those with confirmed diagnosis at endoscopy. Vitamin D deficiency was defined as <50nmol/l. Results: 179 patients had a Vitamin D level recorded;58 Ulcerative colitis (UC), 58 Crohn's disease (CD), 53 non-IBD controls and 10 still awaiting diagnosis. 44(76%) CD, 32(55%) UC and 28(53%) non-IBD control patients were Vitamin D deficient at first presentation. Median levels were lowest in CD, with a significant difference between CD and non-IBD (median 35nmol/l;IQR 24.05 vs. median 48.9nmol/l;IQR 49.1;p=0.004). Regression analysis demonstrated patients with Crohn's disease were four times more likely to have Vitamin D deficiency compared to UC (OR 4.08;95% CI 1.35-12.36) at diagnosis. No correlation was seen between absolute vitamin D levels or vitamin deficiency state and faecal calprotectin when controlled for various factors regardless of the IBD subtype. The cohort distributions are demonstrated in Figure 1. Within the IBD cohort, Vitamin D levels were significantly lower in Black or Asian patients vs White patients (median 28.5;IQR 20.85 vs median 43.3;IQR 33.95;p=0.004). Figure 2 provides an overview of the cohort distributions. Vitamin D levels at presentation, as demonstrated in Table 1, did not correlate with Disease activity markers (DAMS) whereas baseline haemoglobin did, albeit weakly. Interestingly, Vitamin D and Haemoglobin correlated without reaching statistical significance (Spearman's rho 0.149;p=0.08). Conclusion: Our inception dataset demonstrates high rates of Vitamin D deficiency comparable to prior studies in IBD patients. Both CD and Black or Asian ethnicity were strongly associated with Vitamin D deficiency. Baseline Vitamin D did not correlate with disease activity markers whereas anaemia showed consistent weak association. Our study demonstrates the problem of hypovitaminosis D and the importance of measurement and supplementation, particularly in Black and Asian CD patients, from diagnosis.

Operational K9s in the COVID-19 World

Severe acute respiratory syndrome coronavirus 2 (SARSCov- 2) is hypothesized to have originated from a spillover event from an animal reservoir. This has raised many questions, with an important one being whether the widely disseminated coronavirus disease 2019 (COVID-19) is transmissible to other animal species. SARS-CoV-2 is primarily transmitted person to person. K9-to-human transmission, although theoretically possible via fomites, is considered minimal, if at all, and there have been no reported cases of K9-to-human transmission. Human-to-K9 transmission, although rare, seems more likely;however, in only one case has a K9 been suspected to have displayed symptoms of COVID-19. Preparation, decontamination, hand hygiene, and distancing remain the key factors in reducing transmission of the virus. The information presented is applicable to personnel operating within the military conventional and Special Operation Forces as well as civilian Tactical Emergency Medical Services communities who may have the responsibility of supporting an operational K9.